Abstract
Background: Image-guided percutaneous lung biopsy (PLB) may lead to major complications requiring hospitalization. This study aims to evaluate the rate of major PLB complications and determine a predictive computed tomography (CT) score to define patients requiring hospitalization due to these complications.Methods: This single-center retrospective study included all PLBs performed from July 2019 to December 2020 in Nimes University Hospital, France. Patients who were undergoing thermo-ablation during the same procedure or for whom PLB procedure data were not available were excluded. All major complications leading to hospitalization were recorded. A Percutaneous Image-guided Lung biopsy In/out Patient score (PILIP) based on variables significantly associated with major complications was calculated by multivariate analysis.Results: A total of 240 consecutive patients (160 men, 80 women; mean age: 67.3±10.5 years) were included. The major complication rate was 10.4%. Length of lung parenchyma traversed <20 vs. 20–40 mm [P=0.017, odds ratio (OR) =5.02; 95% confidence interval (CI): 1.33–18.92] and vs. >40 mm (P=0.010, OR =6.15; 95% CI: 1.54–24.53), middle vs. superior lobar location (P=0.011, OR =6.34; 95% CI: 1.53–26.31), emphysema along the needle pathway (P<0.0001, OR =10.96; 95% CI: 3.61–33.28), and pleural/scissural attraction (P=0.023, OR =3.50; 95% CI: 1.19–10.32) were independently associated with major complications. Based on these parameters, the PILIP made it possible to differentiate low-risk patients (PILIP <4) from those at high risk (PILIP ≥4) of major complications with 0.40 sensitivity (95% CI: 0.21–0.59), 0.95 specificity (95% CI: 0.93–0.98), a positive predictive value of 0.50 (95% CI: 0.28–0.72) and a negative predictive value of 0.93 (95% CI: 0.90–0.97).Conclusions: PLB showed a major complication rate of 10.4%. The PILIP is an easy-to-use CT score for differentiating patients at a low or high risk of complications requiring hospitalization.